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YEAR 6: PACES > Surgery 8 > Flashcards

Surgery 8 Flashcards

1
Q

What are the benefits of Hickman lines over PICC lines?

A

PICC lines are not suitable for all medications
PICC lines block more easily
PICC lines may cause clots in your arm

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2
Q

What are the features of Leriche syndrome?

A

Buttock claudication and wasting
Erectile dysfunction
Absent femoral pulses

NOTE: caused by aorto-iliac insufficiency

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3
Q

List some complications of TURP.

A

IMMEDIATE: TURP syndrome, haemorrhage
EARLY: haemorrhage, infection, clot retention (requires bladder irrigation with 3-way catheter)
LATE: retrograde ejaculation, erectile dysfunction, incontinence, urethral stricture, recurrence

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4
Q

What are the advantages and disadvantages of suprapubic catheterisation?

A

ADVANTAGES: reduced risk of UTI, reduced risk of stricture formation, patient preference, maintain sexual function
DISADVANTAGES: more complex, risk of serious complications (viscus perforation, haemorrhage, malignancy seeding)

NOTE: contraindicated if suspected bladder cancer, undiagnosed haematuria or previous lower abdominal surgery (adhesions)

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5
Q

What are the main types of testicular tumour?

A

Seminomatous (50%)
Non-Seminomatous: teratoma is most common
Yolk sac tumour (most common in children)
Leydig or Sertoli cell tumour (may produce oestrogens)
Lymphoma (NHL is most common testicular mass in > 60 yrs)

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6
Q

Outline the surgical management of inguinal hernias.

A

Open surgery: Lichtenstein tension-free mesh, Shouldice suture repair
Laparoscopic: TEP or TAPP repair
TEP: totally extraperitoneal (peritoneum not incised)
TAPP: transabdominal pre-peritoneal (peritoneum incised)

NOTE: laparoscopic is better for bilateral hernias, no mesh needed in children

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7
Q

List some conditions that cause lipomas.

A

Dercum’s disease - multiple painful lipomas, peripheral neuropathy, obesity
Familial multiple lipomatosis
Madelung’s disease (multiple symmetric lipomatosis - mainly causes symmetrical lipomas on shoulders)
Bannayan-Zonana syndrome

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8
Q

What is a cholesteatoma?

A

In-growing stratified squamous epithelium of the ear drum within the middle ear
Leads to chronic foul discharge, hearing loss, facial nerve damage and vertigo
Can lead to deafness, meningitis and brain abscess

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9
Q

What are the borders of the femoral canal?

A

Medial: lacunar ligament
Lateral: femoral vein
Anterior: inguinal ligament
Posterior: pectineal ligament

NOTE: contains fat and Cloquet’s node (femoral nerve, artery and vein are lateral to the femoral canal)

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10
Q

What are the indications for immediate CT head scan (within 1 hour) in patients who have had a head injury?

A

GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
Suspected open or depressed skull fracture.
Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
Post-traumatic seizure.
Focal neurological deficit.
More than 1 episode of vomiting

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11
Q

List some causes of shoulder pain with or without reduced range of motion.

A 
Rotator cuff tear/tendonitis 
Subacromial bursitis
Adhesive capsulitis (frozen shoulder) 
Synovitis 
Osteoarthritis 
Dislocation 
Fracture of the humeral head
Referred pain from the diaphragm
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12
Q

Which operations are likely to require a loop colostomy?

A

RUQ: defunctioning transverse colostomy to cover a distal anastomosis (RARE)
LIF: apex of sigmoid exteriorised without resection for inoperable colorectal cancer that is likely to obstruct

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13
Q

List some differentials for midline neck masses.

A

Thyroid isthmus mass
Inclusion dermoid cyst
Thyroglossal cyst

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14
Q

What is a dermoid cyst?

A

Epidermal-lined cyst deep in the skin
Congenital (inclusion cyst) - forms along lines of skin fusion (e.g. midline neck, lateral eyebrows)
Acquired/implantation cyst - often secondary to piercing

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15
Q

What does the McMurray test look for?

A

Meniscal tears

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16
Q

EPONYMOUS OPERATIONS: pyloric stenosis

A

Ramstedt pyloromyotomy - longitudinal incision through muscularis propria at pylorus

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17
Q

What is the main indication for abdomino-perineal resection?

A

Tumours lying within 4-5 cm of the anal verge

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18
Q

List some complications of mechanical ventilation.

A

Pneumothorax
Fluid retention
Ventilator-induced lung injury
Ventilator-associated pneumonia

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19
Q

Outline the management of Dupuytren’s contractures.

A

Non-Surgical: physiotherapy, steroid injections, allopurinol

Surgical: fasciotomy, partial fasciectomy (Z-plasty), arthrodesis

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20
Q

List some complications of carpal tunnel decompression surgery.

A

Hypertrophic and keloid scars
Scar tenderness
Nerve injury (palmar cutaneous branch of median nerve, motor branch to thenar muscles)
Failure to relieve symptoms

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21
Q

What causes winging of the scapula?

A

Serratus anterior weakness

May be due to long thoracic nerve injury, upper brachial plexus injury and muscular dystrophy (fascio-scapulo-humeral)

22
Q

Outline the surgical management of extracapulsar neck of femur fractures.

A

ORIF with dynamic hip screw

23
Q

What are the different types of external fixation?

A

Monoplanar

Multiplanar

24
Q

What are the advantages and disadvantages of minimal access surgery?

A 
ADVANTAGES
- reduced post-op pain
- reduced risk of wound infection 
- faster recovery 
- reduced hospital stay 
- better cosmetically 
DISADVANTAGES
- reduced tactile feedback 
- old skills may be lost 
- complications (e.g. bleeding) may be harder to manage 
- expensive
25
What are the main approaches to preventing problems with fracture union?
Optimise physiology: treat/prevent infection, bone graft, ensure adequate blood supply, bone morphogenetic protein Optimise mechanics: external fixation, internal fixation
26
List some complications of surgical management of NOF fractures.
Avascular necrosis of femoral head (if displaced fracture) Non/malunion Infection Osteoarthritis
27
What does pain on straight leg raise suggest?
Lumbosacral nerve root irritation NOTE: Lesague sign is worsening pain on dorsiflexion of the foot
28
Which ducts connect the submandibular and parotid glands to the oral cavity?
Submandibular - submandibular duct (Wharton's duct) - adjacent to frenulum Parotid - parotid duct (Stensen's duct) - opposite 2nd maxillary molar
29
Which operations are likely to require an end ileostomy?
Permanent: panproctocolectomy (e.g. UC) Temporary: total colectomy with later ileal pouch-anal anastomosis (e.g. FAP)
30
EPONYMOUS OPERATIONS: Achalasia
Heller's cardiomyotomy - longitudinal incision through muscularis propria at lower oesophageal sphincter
31
What are some major contraindications for using a nasopharyngeal tube?
Facial injuries | Basal skull fracture (Raccoon eyes, Battle sign, haemotympanum, CSF rhinorrhoea/otorrhoea)
32
Which surgical treatment options are considered in UC patients?
Subtotal colectomy with end ileostomy +/- mucus fistula (can be followed with ileorectal anastamosis, IPAA or permanent end ileostomy) Proctocolectomy and end ileostomy
33
Describe Buerger's test.
Lift both legs to 45 degrees and observe for pallor and venous guttering The angle at which the foot goes white is Buerger's angle When the foot blanches, swing the legs over the side of the bed and let them hang The ischaemic foot will go brick red (reactive hyperaemia) NOTE: this indicated significant peripheral arterial disease
34
What is thoracic outlet syndrome?
Venous - upper limb DVT and swelling Arterial - Raynaud's, claudication, embolisation Neurological - pain, radiculopathy NOTE: caused by compression between the 1st rib, clavicle and scalenus anterior. It is investigated using MRI, Duplex and nerve conduction studies
35
List some indications for using a larngeal mask airway.
Non-definitive airway for short day-case surgery | Emergency situations if unable to insert ET tube
36
List some causes of gynaecomastia.
Drugs (spironolactone, digoxin, ranitidine, verapamil, captopril, anabolic steroids) Physiological (puberty) Hypogonadism (hyperprolactinaemia, renal failure, testicular atrophy, Klinefelter's) Increased oestrogens (sex cord stromal tumours, lung cancer, chronic liver disease, thyrotoxicosis)
37
Which classification system is used for diverticulitis?
``` Hinchey Grading 1 = small confined pericolic abscess 2 = large abscesses extending into the pelvis 3 = purulent peritonitis 4 = faecal peritonitis ``` NOTE: 1-2 rarely require surgery, 3 requires at least on table washout, 4 requires Hartmann's
38
Which classification system is used for pelvic fractures?
``` Young and Burgess classification Lateral compression (ipsilateral pubic ramus fracture) AP compress (open book fracture) Vertical shear (inherently unstable) ``` NOTE: complications include haemorrhage, urethral injury and bladder injury
39
What is Goodsall's law?
If the external opening of an anal fistula is posterior to the transverse anal line, it will follow a curvilinear path opening in the posterior midline of the anal canal If it is anterior to the transverse anal line, it will have a radial fistulous tract.
40
What is the difference between an open and a closed surgical drain?
Open: fluid collects into dressing or stoma bag (e.g. corrugated rubber, plastic sheets) Closed: tube is attached to a container (e.g. chest drain)
41
What are the contents of the inguinal canal in males?
Spermatic cord | Ilioinguinal nerve
42
Outline the staging of prostate cancer.
Stage 1 and 2 - can't be palpated on DRE Stage 3 - can palpate on DRE Stage 4 - metastasised
43
List some indications for bypass grafting in chronic limb ischaemia.
Very short claudication distance Symptoms greatly affecting patient Rest pain
44
What is the main purpose of a CT urogram?
Pick up filling defects NOTE: it takes a control film, then another image 5 mins after contrast administration and the final one at 15 mins after contrast
45
List some causes of a persistent hoarse voice.
``` Nodules Polyps Reinke's oedema Granuloma Laryngeal cancer ```
46
Which classification system is used for fractures of the growth plate?
Salter-Harris classification 1 - Straight across growth plate 2 - Above the growth plate (diaphyseal side) 3 - Lower than growth plate (epiphyseal side) 4 - Through the growth plate 5 - crush NOTE: 2 is most common and 5 has the worst prognosis
47
Outline the management of incisional hernias.
Surgery not always necessary as hernias are usually broad-necked and low risk of strangulation Manage risk factors (e.g. treat cough, weight loss) Surgery: nylon mesh repair
48
List some indications for central venous catheters.
Central venous pressure measurement (for fluid balance) Drug administration (amiodarone, mannitol, potassium) Total parenteral nutrition
49
How can direct and indirect inguinal hernias be distinguished on examination?
Reduce the hernia Place 2 fingers over the deep inguinal ring (midpoint of inguinal ligament) Ask patient to cough (hernia pops out if it is direct) NOTE: ultrasound can be used to identify hernias
50
What is the main indication for a urostomy?
Total cystectomy

YEAR 6: PACES (22 decks)

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